The gynecologist is likely the first specialist to field patient questions about fertility, and patients rely on her to alert them when they need to see a fertility specialist – a reproductive endocrinologist.
Current medical guidelines to consult a fertility specialist are following:
Women over the age of 35 who have been trying to conceive for 6 months with regular intercourse but have not gotten pregnant or women under the age of 35 who have been trying to conceive for 1 year with regular intercourse but still have not gotten pregnant should go to the consult.
p.s. Don’t neglect the consult also if you have had more than one miscarriage, painful menstrual periods, have irregular menstrual cycles, have had a previous pelvic infection or gynecological surgery, or a family history of endometriosis or other fertility-related diagnoses.
What Is Reproductive Endocrinology?
Reproductive endocrinology and infertility (REI) is a surgical subspecialty of obstetrics and gynecology that trains physicians in reproductive medicine addressing hormonal functioning.
Most REI specialists primarily focus on the treatment of infertility, but reproductive endocrinologists are trained to also evaluate and treat hormonal dysfunctions in females and males.
That is not an easy task!
It requires 4 years of medical school FOLLOWED BY completion of a 4-year residency in obstetrics and gynecology. Training includes (among other things):
- delivering babies,
- care of pregnant women,
- medical and surgical treatment of disorders of the female reproductive system.
And then – AFTER completing a residency program, a physician would apply to receive additional training in reproductive endocrinology.
This includes a 3-year intensive training program, which focuses on understanding the complexities of the female reproductive system.
Not for the faint-hearted, huh?
Who Is A Reproductive Endocrinologist?
Reproductive endocrinologists are obstetrician-gynecologists (obygyn) with advanced education, research and professional skills in reproductive endocrinology and infertility.
They specialize in the following fields:
- tubal factor infertility,
- male factor infertility,
- fertility preservation,
- congenital uterine anomalies,
- polycystic ovarian syndrome (PCOS),
- hypothalamic-pituitary dysfunction,
- a congenital adrenal hyperplasia,
- in vitro fertilization (IVF),
- other disorders of the female reproductive tract.
Reproductive endocrinologists can employ fertility drugs, IUI, IVF, surgery and other techniques to enable childbearing.
Many conduct research, participate in clinical trials, and are often faculty members in reproductive endocrinology at medical schools, helping to advance the science and practice of assisted reproductive technology (ART).
They are the physicians who keep up with all the advances in this fast-changing field that gynecologists do not have the time nor expertise to incorporate into their practice.
Reproductive Endocrinologist Or Fertility Specialist?
You say tomato, I say tomato.
The unimportant difference in terminology? I think not.
Titles like fertility specialist, infertility specialist, the fertility doctor, infertility doctor, a doctor who specializes in fertility and infertility and so on. Those titles are essentially meaningless.
There is no medical or governmental group overseeing of any of those titles. But there is 1 thing you can rely upon…
…thankfully in a number of countries, the pathway of becoming a subspecialist in reproductive endocrinology and infertility is regulated.
For example in the USA, the reproductive endocrinologists receive board certification by the American Board of Obstetrics and Gynecology in both obstetrics and gynecology and reproductive endocrinology and infertility.
To sum up – every reproductive endocrinologist is a fertility specialist, but not every fertility specialist is a reproductive endocrinologist.
What Is The Role Of A Reproductive Endocrinologist?
One of the most important skills for a reproductive endocrinologist is to decide which type of treatment is best for each individual patient and when to perform them:
- some patients are better off trying on their own for a little longer,
- others should start by trying intrauterine insemination (IUI) cycle (Purifying a sperm sample and transporting the final improved concentrated product deep into the uterus on the optimal day.),
- others are best served by going directly to in vitro fertilization (IVF) (The gold standard of treatment. This consists of taking the eggs out of the female body and directly putting it together with sperm to create embryos.),
- still others are best advised to give up and look at alternatives such as adopting or quitting altogether (one of the hardest things to advice).
Making the optimal decision requires gathering information through interviewing the patients, examining them and ordering tests.
There are few routine tests to determine your cause of infertility:
- The presence of sperm, which is done by semen analysis.
- The ability of the sperm to travel through the cervix.
- The hysterosalpingogram (HSG), to evaluate the patency of the fallopian tubes.
- To evaluate if you are ovulating.
- To confirm normal anatomy. To sure the uterus and the internal reproductive organs are functioning properly, allowing an opportunity for sperm to fertilize an egg.
Many times, the success depends on the surgical procedures. Common surgical procedures that are performed in reproductive medicine are:
- laparoscopy (an operation performed in the abdomen or pelvis through small incisions with the assistance of a laparoscope attached to a camera),
- hysteroscopy (inspection of the uterine cavity through the cervix by a hysteroscope attached to a camera),
- abdominal myomectomy (removal of uterine fibroids).
How Do You Know When It Is The Time To See A Reproductive Endocrinologist Instead Of Your Gynecologist?
Reproductive endocrinologists are sought when a patient has particular abnormalities or has been struggling to get pregnant for a long period of time.
They might get involved when a woman has suffered repeated miscarriages. Reproductive endocrinologists often enter the picture when gynecologist have already tried some basic treatments and counseled patients who are attempting natural conception:
- A reproductive endocrinologist will provide a comprehensive fertility workup. Complete with blood work, ultrasound, semen analysis for your partner, medical history, and fertility tests like hysterosalpingogram (HSG) to make sure your fallopian tubes are open.
- A reproductive endocrinologist will assess your likelihood of conceiving at your age with your respective male factor or female factor infertility diagnosis.
- A reproductive endocrinologist will closely monitor you throughout your fertility treatment cycle via blood work and ultrasound every few days or daily as your cycle progresses.
- A reproductive endocrinologist will look at your fertility tests and your partner’s semen analysis to devise the treatment plan that’s right for you. She will use the semen analysis as a guide to determine the need for doing IVF with intracytoplasmic sperm injection (ICSI) to bypass severe male factor infertility.
How Does The First Appointment With Reproductive Endocrinologist Look Like?
The path to an reproductive endocrinologist office is often emotional and overwhelming. After all – you just got the news that there are possible issues with your conception.
My biggest advice would be: be open and ask ALL the questions you may have.
Ask your fertility doctor questions like:
- What are your chances of getting pregnant? (Review your personal and medical history to get a clearer idea of the chances of conceiving and having a baby. Be honest about your medical and sexual history.)
- What types of fertility testing will you undergo? (There are a number of fertility tests for women while men usually start with a semen analysis.)
- What is your success rate with IVF? (Be careful, clinics have different ways of measuring success! Ask the reproductive endocrinologist about the live delivery rate of a woman with a similar diagnosis, age, and treatment plan.)
- What are the side effects of fertility treatments? (Remember, any time you take hormones, you run the risk of mood swings, hot flashes, depression, etc.)
- How much will the treatment cost? (The reproductive endocrinologist should tell you about the actual cost of the treatment plan.)
Reproductive endocrinologist will need to understand the cause of your infertility. The initial visit will focus on education, followed by a thorough explanation of what it takes to conceive and the testing (blood work) to help determine the cause of your infertility.
Choosing A Reproductive Endocrinologist: What I Wish I’d Known
A lot of women have a million questions before visiting a reproductive endocrinologist. In the article Choosing A Reproductive Endocrinologist: What I Wish I’d Known Erin McDaniel talks about things she wished to know prior to the visit:
- Allow Scary or Shocking News to Settle Before You Act. (Wait a day, a week, or more to process the information you’ve been given before you decide what to do next.)
- Do Your Research. (There is so much stress in the unknown. When we don’t feel we have enough information, we don’t feel we can be part of the conversation.)
- Be an Advocate for Yourself. (This is your body, your money, and your family. You can—and should—be a key decision-maker in your care.)
- Build a Circle of Support. (A critical component of surviving infertility is emotional support. Creating a support team of friends and family can help you process your emotions, renew your hope in the face of disappointment, and share experiences.)
A great read!
Frequently Asked Questions
- Are Reproductive Endocrinologists In USA Covered By Insurance?
- Can A Reproductive Endocrinologist Deliver Babies?
- What Is The Use Of Ultrasonography In Reproductive Endocrinology?
- How Much Do Reproductive Endocrinologists Make?
- They average 53 hours of work per week: 44% work in academia and 50% in private groups.
- Compared with academia, those in private practice reported higher compensation, less major surgery, more IVF, less endocrinology, and less research.
- Average practice size was 5.5, with an average of 470 fresh IVF cycles performed per year.
- Percent effort included 63% infertility, 10% endocrinology, 10% surgery, and 9% research.
- Respondents performed an average of 13 major surgeries, 69 minor surgeries, and 128 oocyte retrievals per year.
- 92% would again choose reproductive endocrinology and infertility as a career.
The biggest issue behind this question is probably the cost of IVF cycles (Basic IVF can be as much as $15,000 and this number does not include the cost of medications, which may be as high as $3,000 per cycle.).
15 federal states require insurers to provide some degree of infertility coverage or offer the option of coverage to those buying plans, many of those mandates impose restrictions (Some insurance plans, provide coverage only for the diagnostic phase of infertility treatment.) on who can qualify, raising questions about who should be covered by infertility insurance.
Familiarize yourself with your individual state’s policies!
Yes, although the majority of the doctors who deliver babies are obstetrician-gynecologists.
With ultrasound, you can evaluate the ovaries and the follicles or eggs within the ovary, as well as the uterus, including the endometrium, or lining.
$333,824. In my humble opinion, they deserve each penny!
Practice patterns, satisfaction, and demographics of reproductive endocrinologists: results of the 2014 Society for Reproductive Endocrinology and Infertility Workforce Survey
Before the conclusion of the article, I would like to present the results of the 2014 survey of Society for Reproductive Endocrinology and Infertility. Their objective was to identify the current and future state of the practice of reproductive medicine.
I would like to hear from you what is your experience with the reproductive endocrinologist.
I’d love to hear any thoughts at all on the topic.
Leave the comment below and let’s talk about it.
With love, Monika.
p.s. If you enjoyed this article, check my previous one, where I talked about Everything You Need To Know About The Short Luteal Phase
p.p.s. If you enjoyed this article, I’d be very grateful if you’d help it spread by emailing it to a friend or sharing it on Twitter or Facebook. Thank you!
About The Author
Monika Setinc is a mother, businesswoman and a Chief Engagement Officer with Kunapipi. She spends her free time with her little son.